Beta-blockers are licensed and officially approved to help treat the symptoms of:

• Anxiety (GAD or Generalised Anxiety Disorder), e.g. palpitations, sweating, shakiness etc.

• Hypertension (high blood pressure), angina, arrhythmias and some other heart conditions

Beta-blockers can also sometimes be used to help the symptoms of:

• PTSD (Post-Traumatic Stress Disorder)

• Seasonal Affective Disorder

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Anxiety - main options, main medicines and handy chart

• PTSD - main options, main medicines and handy chart

• Seasonal Affective Disorder - main options, main medicines and handy chart

• Social anxiety - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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When you are anxious, your brain becomes more active and alert. Your brain may then make more of the chemical messengers called noradrenaline and adrenaline. These will then cause your body to have a faster heart rate, shake, sweat etc. and make you feel more anxious. The beta-blockers reduce the effect of these transmitters and so reduce the physical symptoms of anxiety. There are other drug treatments for anxiety e.g. the benzodiazepines (diazepam etc.).

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Take your beta-blocker as directed on the medicine label. Try to it them at regular times each day. Taking them at meal times may make it easier to remember as there is no problem about taking any of these drugs with or after food.

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Tablets and capsules:
Tablets should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in the throat. The capsules should be swallowed whole with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in the throat. The capsules are a "sustained-release" preparation and should not be sucked or chewed.
Liquid:
Your pharmacist should give you a medicine spoon. Use it carefully to make sure you measure the correct amount. Ask your pharmacist for a medicine spoon if you do not have one.

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This may depend on what you are taking it for. Click the link below for the answer for that condition:

• Anxiety (GAD or Generalised Anxiety Disorder)
• PTSD (Post-Traumatic Stress Disorder)
• Seasonal Affective Disorder

They should start to work on your symptoms of anxiety fairly soon after you start to take them e.g. within a few hours.

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This will depend on what you are taking it for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Anxiety (GAD or Generalised Anxiety Disorder)
• PTSD (Post-Traumatic Stress Disorder)
• Seasonal Affective Disorder

This should be discussed with your doctor as different people respond differently. The beta-blockers are best taken in a fairly low dose as a "first aid" measure.

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The beta-blockers are not addictive. They only act on the physical symptoms of anxiety. It is not a good idea to stop them suddenly. This is because they can be taken in higher doses for heart conditions, suddenly stopping it can sometimes cause problems such as palpitations (heart beat increasing) or a rise in blood pressure.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Beta-blockers have none of these and so are not addictive. Any discontinuation effects are more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose. Do not try to catch up by taking two or more doses at once as you may get more side-effects. If you miss several doses start again when you remember. Tell your doctor about this next time you meet. Missing the occasional dose (e.g. once a week) isn't usually a big problem.

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It is best not to stop taking a beta-blocker suddenly if you have been taking them regularly every day for more than about 4 to 6 weeks, although there probably would be no great problem. A gradual reduction in your dose is probably best.

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The table below will show you some of the main side effects you might get from propranolol or oxprenolol.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Some people do feel a little drowsy or sleepy with beta-blockers, particularly at the start of treatment, but this should wear off. If you do feel drowsy, you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as they may affect your reaction times.

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It is not thought that the beta-blockers cause any great changes in weight although it has been reported that a few people put on a small amount of weight over several years. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Beta-blockers do not have any known significant effects on any of these stages. Higher doses may reduce blood pressure in some people (which is often why they are prescribed), which may make it more difficult for men to have an erection. In some people, reduced anxiety may be an advantage.

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You should have no problem with any foods or drinks, other than alcohol (see separate question).

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

Alcohol may slightly reduce the effect of your beta-blocker, but this is unlikely to be a problem.  

It is not safe to drive after drinking alcohol, with or without a beta-blocker. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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You should have no problems if you take beta-blockers with other medications although a few problems can occur. Make sure your doctor knows about any other medicines you are taking. Make sure your doctor knows about any heart, breathing, thyroid or diabetic problems you have had in the past e.g. you should not normally take a beta-blocker if you have asthma.

The beta-blockers can "interact" with some other drugs e.g. for high blood pressure, glaucoma and some antidepressants. This does not necessarily mean the drugs can not be used together, just that you may need to follow your doctor's instructions very carefully. You should tell your doctor before starting or stopping these or any other drugs. There are other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking.

The beta-blockers are such medicines. The amount of a beta-blocker in the body can drop a little if you smoke, giving less effect or meaning you might need a higher dose to get the same effect. It also means that if you stop smoking, the levels will rise so you might get more side effects. But the effect is probably small.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, there are no extra problems with smoking cannabis, other than the smoking itself (see above).

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with a beta-blocker and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with a beta-blocker and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with a beta-blocker, although you might feel more drowsy.

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You should have no problems with "The Pill" and propranolol or oxprenolol.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking a beta-blocker, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily propranolol and oxprenolol don't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

The beta-blockers propranolol and oxprenolol are classified as "C". There is no proven evidence of a teratogenic effect, and animal tests show a low risk of danger. Some problems have been reported, especially later in pregnancy, and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice. Reducing your dose a few weeks before your due date may also be possible.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.

• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.

• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter

• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit

• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half

• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that some propranolol gets into breast milk but this is probably only at low levels (0.1%, well below the 10% "safe" level). You should talk about this to your doctor, nurse or health visitor because they will be able to do regular checks on your baby to make sure there are no problems. 

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The beta-blockers can reduce your ability to carry out skilled tasks such as driving or operating machinery. You may also feel drowsy when you start to take them. Until these effects wear off or you know how your drug affects you do not drive or operate machinery. You should be careful as they may affect your reaction times

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You should not need to have a blood or other tests to check on your beta-blocker, although your doctor may want to check your blood for other reasons. You may need to have your blood pressure tested.

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